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Rhode Island rates for HCPCS C5275

Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,090.73 / $2,778.87 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $35.18 / $35.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$765.99 / $1,102.59 / $1,364.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $1,401.00 / $4,915.00